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Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding

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Abstract

Purpose

Transfusion of blood components is common in patients admitted to the intensive care unit (ICU) for gastrointestinal (GI) bleeding, yet the incidence and risk factors for development of transfusion-related acute lung injury (TRALI) in these patients are unknown.

Methods

Patients admitted to a medical ICU for GI bleeding (n = 225) were analyzed for patient- and transfusion-specific risk factors for development of TRALI.

Results

In transfused patients (n = 150), the incidence of TRALI was 15% [95% confidence interval (CI), 10–21%] and accounted for 76% (22/29) of all acute lung injury (ALI) cases. Transfused patients with end-stage liver disease (ESLD) (n = 72) developed TRALI more frequently than those without ESLD (29% versus 1%, p < 0.01). Fresh frozen plasma (FFP) was temporally associated with TRALI in 86% of cases. Transfusion-specific risk factors for development of TRALI included number of transfused units of FFP and nonleukoreduced red blood cells. Patient-specific risk factors included Model for End-Stage Liver Disease (MELD) score, admission serum albumin level, and presence of ALI risk factors.

Conclusions

TRALI is common in critically ill ESLD patients with gastrointestinal bleeding. Nonleukoreduced red blood cells and FFP are significant transfusion-specific risk factors and their use should be re-evaluated in bleeding patients with ESLD.

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Acknowledgments

National Heart, Lung and Blood Institute, National Institute of Health; K24 HLO89223. National Institute of General Medical Sciences, National Institute of Health; Grant GM49222. American Gastroenterological Association Research Scholar Award.

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Authors and Affiliations

  1. Division of Pulmonary Sciences and Critical Care, University of Colorado Denver, Anschutz Medical Campus Research 2, Box C272, 9th floor, 12770 East 19th Ave., Aurora, CO, 80045, USA

    Alexander B. Benson & Marc Moss

  2. Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO, 80045, USA

    Gregory L. Austin & Hugo Rosen

  3. Department of Pathology, University of Colorado Denver, Aurora, CO, 80045, USA

    Mary Berg

  4. School of Public Health, University of Colorado Denver, Aurora, CO, 80045, USA

    Kim K. McFann

  5. Bonfils Blood Center, Denver, CO, USA

    Sila Thomas, Gina Ramirez & Christopher C. Silliman

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  1. Alexander B. Benson
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  2. Gregory L. Austin
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Correspondence to Alexander B. Benson.

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Benson, A.B., Austin, G.L., Berg, M. et al. Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding. Intensive Care Med 36, 1710–1717 (2010). https://doi.org/10.1007/s00134-010-1954-x

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  • DOI: https://doi.org/10.1007/s00134-010-1954-x

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